Information Collection Request
Long Term Care Hospital (LTCH) Quality Reporting Program (CMS-10409)
ICR 202305-0938-006 · OMB 0938-1163 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1163 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10409 Long Term Care Data Set |
Form and Instruction | Modified | Repair queued |
 CMS-10409_Supporting Statement Part A_5.1_v9_to 508.docx |
Supporting Statement A | Uploaded 2023-05-31 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 201171 |  Long Term Care Data Set |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1163 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202204-0938-008 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |